Del Nido cardioplegia as a safe and effective method of myocardial protection in adult patients undergoing cardiac surgery: A single-center experience

Abstract

Background Del Nido (DN) cardioplegia is increasingly popular in adult cardiac surgery. It allegedly allows for up to 90 minutes of safe myocardial ischemia with a single dose. Aims We aimed to evaluate the benefits of DN cardioplegia. Methods Of the 2108 patients undergoing coronary or heart valve surgery with the use of cardiopulmonary bypass (CPB) between January 1, 2016, and September 30, 2017, 1236 (59%) received DN and 872 (41%) received cold blood cardioplegia. We retrospectively analyzed the collected data of all consecutive on-pump patients to assess early mortality and postoperative troponin T release. A multivariable analysis of both outcomes adjusted for propensity to receive DN cardioplegia was performed. Results Patients protected with DN cardioplegia had longer CPB and aortic cross-clamp times (P <0.001) but received fewer doses of cardioplegia. Median postoperative troponin T levels were higher in the DN-cardioplegia than CB-cardioplegia group: 0.324 ng/ml (interquartile range [IQR], 0.210-0.559 ng/ml) vs 0.285 ng/ml (IQR, 0.191-0.496 ng/ml); P = 0.01. However, when adjusted for the cross-clamp time, propensity to receive DN cardioplegia, and other factors, DN cardioplegia was associated with lower postoperative troponin T levels. Early mortality rates did not differ between DN and CB cardioplegia (3.6% vs 3%; P = 0.54). Conclusions Del Nido cardioplegia is a safe and effective method of myocardial protection in adults. It allows for a longer redosing interval with a safety profile and mortality comparable to those for CB cardioplegia, as shown by lower troponin T release when corrected for the time of myocardial ischemia.